Objective Sleep is often disturbed in patients with advanced cancer. There is limited knowledge about sleep in patients with cancer treated with strong opioids. This study examines sleep quality in patients with advanced cancer who are treated with a WHO Step III opioid for pain.
Methods An international, multicentre, cross-sectional study with 604 adult patients with cancer pain using WHO Step III opioids. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) global score (range; 0–21; score >5 indicates poor sleep). PSQI includes sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medications and daytime dysfunction. Pain and quality of life were assessed by Brief Pain Inventory and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core30.
Results The median age was 62 years, 42% were female, mean Karnofsky performance score (KPS) was 62.5 (±14.2) and mean oral daily morphine equivalent dose was 303 mg/24 hours (±543.8 mg). The mean PSQI global score was 8.8 (±4.2) (range 0–20). Seventy-eight per cent were poor sleepers. All PSQI components were affected, and 44% reported trouble sleeping caused by pain. In the multiple regression model, predictors of PSQI global scores were pain intensity, emotional function, constipation, financial difficulties and KPS (adjusted R2=0.21).
Conclusion The majority (78%) of these patients with cancer treated with Step III opioids experienced poor sleep quality. Pain intensity, emotional function, constipation, financial difficulties and KPS predicted poor PSQI global scores. The clinical implication is that healthcare personnel should routinely assess and treat sleep disturbance in patients with advanced cancer disease.
- symptoms and symptom management
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Contributors GJ, SK and PK were responsible for the conception of the study. GJ, SK, MK, RS and PK collected the data, which were analysed by GJ, PF and PK. Data were interpreted by GJ, ME, PF, MJH and PK and confirmed by all authors. All authors were involved in drafting and critically appraising the manuscript before providing final approval.
Funding The study was funded by The Norwegian Research Council and the European Union’s 6th framework (contract 037777). GJ has funding from The Liaison Committee for Education, Research and Innovation in Central Norway.
Competing interests None declared.
Patient consent Obtained
Ethics approval Regional Medical Research Ethics Committee (ref 119-03). The study was approved by ethical committees at each study centre or in each country before initialisation.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Gunnhild Jakobsen and Pål Klepstad have access to the full data set.